Introduction: We investigated the age of starting Estrogen replacement therapy as a key parameter for reaching near normal Final Height (FH) in Chronic Kidney Disease (CKD) girls with growth retardation. Although Growth Hormone (GH) therapy significantly increase final height in children with CKD, these children's final height remain under normal population height in several studies. As normal puberty is a key point to reach normal final height, unmet needs of CKD children in the case of both delayed puberty and delayed thelarche may be the missing subjects. In fact, endocrinologists neglect onset of puberty and only add estrogen when they can confirm delayed puberty after 13.5 yrs old that lead to not so arbitrary final height in spite of GH treatment. Method: This open label, quasi-experimental designs, matched controlled clinical trial was performed on CKD girls with short stature and delayed thelarche or delayed puberty according to clinical and laboratory investigations. Participants group 1 and 2 had been treated with GH, and Ethinyl Esradiol (EE) was administered from 11yrs old with delayed thelarche and 13.5 yrs old with delayed puberty in group 1 and 2 respectively. Group 3 was selected from patients that did not accept to start GH or EE till 15 years old. The effect of the age of starting EE on FH, GH therapy outcomes, bone density, and calcium profile were evaluated. Result: Finally 16, 22, and 21 patients analyzed as group 1, 2, and 3 respectively. Mean Mead Parental Height (MPH) in group 1, 2, and 3 had not significant difference between groups. GH therapy significantly enhanced mean final height in groups 1 and 2 in comparison with group 3 (β= -4.29, P≺0.001). Also multivariable backward linear regression illustrated significant negative association between final height and age of starting EE (β=0.26, P≺0.001). mean femoral and lumbar bone density were significantly enhanced after GH and EE therapy (P value: ≺0.001). Conclusion: We recommend to pay more attention to the effect of delay the onset of puberty on growth spurt and final height. Therefore, in spite of serious concern about closure of growth palate because of estrogen replacement therapy, we should not limit it only for after 13.5 yrs old girls and starting EE from 11 yrs old in short stature girls that have no clinical or laboratory sign of sexual maturity till 11 yrs can help to enhance the cost effectiveness of GH therapy.
15 Sep 2022 - 17 Sep 2022